9 Injuries to the Pancreas and Duodenum

10/08 Duodenal and pancreatic injury continues to challenge the trauma surgeon. The relatively rare occurrence of these injuries, the diffi culty in making a timely diagnosis, and high morbidity and mortality rates justify the anxiety these unforgiving injuries invoke. These issues also likely explain the hesitancy of many to address pancreatic injuries with operative intervention and the most recent literature exploring the options and consequences of nonoperative managment.1–3 Mortality rates for pancreatic trauma range from 9 to 34%, with a mean rate of 19%. Duodenal injuries are similarly lethal, with mortality rates ranging from 6 to 25%. Complications following duodenal or pancreatic injuries are alarmingly frequent, occurring in 30 to 60% of patients.4–6 Recognized early, the operative treatment of most duodenal and pancreatic injuries is straightforward, with low morbidity and mortality. Recognized late, these injuries result in a protracted, diffi cult clinical course, often ending in a devastating outcome.7–11